Dr. Alicia Greene - Best of the Best in Pediatric Surgery 2025

The number of SAP bead ingestion cases has significantly increased over the last decade.

From 87 cases identified in literature review, the average patient age was 14 months.

Only 16% of patients had a witnessed ingestion of the foreign body.

Abdominal X-rays were performed in 74% of cases, but only 6% commented on a visualized foreign body.

Ultrasound performed in 57% of cases successfully visualized a foreign body in 86% of instances.

Definitive retrieval of the beads was achieved with surgery in 84% of cases and endoscopy in 8% of cases.

The mean bead size at retrieval was 33.7 millimeters.

Post-operative complications occurred in about 19% of cases, the majority of which were reoperations to remove additional beads not identified in the initial procedure.

Two patients experienced an anastomotic leak requiring an ileostomy.

The median hospital length of stay was six days and one mortality was recorded.

The maximum rate of growth was observed in the first hour for the small and medium beads and between hours 1 and 3 for the large beads in the in vitro experiment.

The medium beads had the greatest growth rate at 305% in simulated small bowel fluid.

Small beads only reached a maximum diameter of less than 1 centimeter, which was not thought to be clinically significant to result in a small bowel obstruction.

The greatest reduction in bead size after 24 hours was noted in beads exposed to GoLYTELY with almost a 40% size reduction, followed by prune juice, Gastrografin and 10% acetylcysteine.

During surgery, a thorough examination of the entire bowel and a high index of suspicion for multiple beads is essential.

Hyperosmolar solutions and osmotic laxatives may have the potential to reduce the size of SAP beads if ingested by children.

The research group was invited by the AAP and APSA advocacy group to share findings and meet with representatives from national recall companies to develop a plan to recall certain products.

Larger beads don't seem to be produced as much but seem to be causing the majority of the problems.

Endoscopic retrieval could only reach beads mainly in the duodenum, maybe proximal jejunum.

Most endoscopic retrievals used a basket but some were able to crush up the beads into small pieces and then allow them to pass on their own.